Adult Health Exam 3 Study Set

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The nurse reviewed discharge instructions with the client newly diagnosed with diabetes type I about how to care for themselves if they have influenza. Which of the following statements by the client would indicate to the nurse that more teaching is required?

"I will need to increase my dose of insulin"

The nurse has taught a client newly diagnosed with Diabetes type I about preparing and administering prescribed dose of regular insulin and NPH insulin. Which of the following statements by the client would indicate to the nurse that more teaching is required? (Select all that Apply)

- I should use the same different body site every time I give myself an injection -I will use 0.5 ml syringes because the line marking should be easy to read

The nurse is assessing the level of risk for complications of a client with pneumonia. Which of the following findings would indicate to the nurse the client will require admission to the hospital for treatment? (Select all that Apply)

-The client is A/O x 1 to self -The client has a BUN level of 24 -The client has a respiratory rate of 33 per minute

The nurse is reviewing a care plan for a group of assigned patients. Which of the following clients should the nurse identify as having the highest risk for developing hyperglycemic syndrome?

55-year-old client with diabetes type II that has pneumonia

A nurse is caring for a client who is having an acute severe asthma attack. Which of the following actions would be priority for the nurse to take?

Administer a prescribed nebulizer beta adrenergic medication

The nurse is caring for a client who has a prescription for regular insulin to be administered before breakfast. The nurse notes that Breakfast trays are delivered at 8 am. After checking the client's glucose level at 7, which of the following actions should the nurse take?

Administer the insulin at 7:30

The nurse is admitting a client who has TB and a productive cough. Which of the following isolation precautions should the nurse implement?

Airborne

The unlicensed personnel reports to the nurse that the client with diabetes type II has a bedside glucose of 65. Which of the following should be a priority by the nurse?

Assess the clients LOC

The nurse is monitoring a client who is receiving moderate sedation. Which of the following would best indicate to the nurse the clients ventilatory effort?

Capnography

The nurse is caring for a client who is admitted with SOB, productive cough, and is suspected of having pneumonia, the nurse should understand that which of the following diagnostic test should be the priority for this client

Chest x-ray

The nurse is developing a care plan for a group of assigned clients. Which of the following clients should the nurse identify as having the highest risk of developing aspiration pneumonia?

Client who has had a cerebral vascular accident

The nurse is monitoring a client with right lower lobe pleural infusion who is post thoracentesis one hour ago. Which of the following requires immediate attention by the nurse?

Diminished breath sounds auscultated in the right base

The nurse is performing a respiratory assessment for a client with pneumonia. The nurse notes that the sound heard when percussing the lower lobes was medium intensity pitch and duration. The nurse should document the finding as the following?

Dull

The nurse is preparing to administer a dose of influenza vaccine to a client. Which of the following allergies documented in the client's medical record should indicate a contraindication to administering the medication?

Eggs

Nurse has taught a client with newly diagnosed hypertension about the DASH diet. Which of the following food choices by the client would indicate to the nurse that more teaching is required?

Hamburger and salad

The nurse is educating a client newly diagnosed with asthma about preventing asthma attacks. Which of the following statements by the client would require follow up by the nurse?

I will choose perfumes that are lightly scented

A nurse has taught a client with allergic rhinitis about managing symptoms. Which of the following statements by the client would indicate to the nurse that teaching was affective?

I will have carpets removed from the bedroom

The nurse has taught a client with type I diabetes about exercise and glucose control. Which of the following statements by the client would indicate to the nurse more teaching is required?

I will increase my daily exercise when ketones are present in my urine (RATIONAL: Don't want ketones in urine sign of ketoacidosis)

The home health nurse is reviewing the daily blood glucose levels of a client with type I diabetes who receives prescribed NPH insulin morning and evenings and Lispro sliding scale with meals. The nurse notes that the client experiences hyperglycemia daily around 6 am. Which of the following would be the best action by the nurse?

Instruct the client to check the blood glucose at 2 am and record the results for a week

The nurse is caring for a client who is 2 hours post op from a tracheostomy. Which of the following would be a priority for the nurse to have at the bedside?

Manual resuscitation bag

A nurse is caring for a client with hypertension who recently started taking Lisinopril. Which of the following if reported by the client would require immediate follow up by the nurse?

My lips seem puffy (Rational: this would be a sign of angioedema)

The nurse is caring for a client with COPD who is receiving prescribed low flow oxygen at 2 L/min via cannula. Which of the following findings would indicate to the nurse that the treatment needs to be revised?

PaO2 level of 55 (Rational: Should be 60 or above)

The nurse is assessing a client with chest pain with inspiration. The nurse notices a friction rub when auscultating breath sounds. Which of the following should the nurse suspect the client is experiencing?

Pleurisy

A nurse is caring for a client with diabetes type I who is experiencing nausea, vomiting, abdominal pain, Kussmual respirations and a fruity scented breath. Which of the following actions by the nurse should be a priority?

Rapidly administering prescribed 0.9 normal saline IV fluids

A nurse is caring for a client with diabetic ketoacidosis who has a prescription for IV infusion of insulin. Which of the following insulins should the nurse anticipate administering to the patient?

Regular

The nurse is assessing a client who is admitted with an upper respiratory tract infection. Which of the following findings is an early indication of hypoxia?

Restlessness

The nurse is implementing nutritional interventions for a client with pneumonia. Which of the following should the nurse include in the plan of care for this client?

Small frequent meals (Rational: digestion take a significant amount of O2, which pneumonia patients do not have enough O2)

The nurse is collecting the health history from client who reports night sweats, hemoptysis, and a recent exposure to TB. Which of the following diagnostic tests should the nurse expect to be prescribed for this client to confirm the diagnosis of TB?

Sputum

The nurse is preparing to measure the blood pressure of a client with a history of hypertension. Which of the following actions should the nurse take

Tell the client to keep feet flat on the floor

The nurse is monitoring a client who experiencing a hypertensive crisis and is receiving prescribed IV infusion of antihypertensive medication. Which of the following findings would indicate that the client is experiencing a complication?

The client appears lethargic

The nurse is educating a client with diabetes type II about newly prescribed Glypizide, Which of the following statements by the nurse best described the action of this drug?

This medication will stimulate your pancreas to increase insulin


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